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Find out by watching this video from our Diabetes Mellitus Masterclass.",{"id":215,"name":216},1,"Course previews",[218,229,234,239,246,250],{"type":219,"data":220},"video",{"readDurationInSeconds":221,"video":222},229,{"platform":223,"name":224,"url":225,"size":226},"YouTube","Adjusting management in the elderly","https:\u002F\u002Fwww.youtube.com\u002Fwatch?v=2_34eFrl9lo",{"width":227,"height":228},200,113,{"type":230,"data":231},"free_text",{"readDurationInSeconds":232,"text":233},11.733333333333333,"\u003Cp>Individualizing glycemic targets for older patients is crucial, particularly given the dangers of getting it wrong! In this video, from our Diabetes Mellitus Masterclass course, we'll review the risks of using certain diabetes medications in older populations, how to balance the risks between hypoglycemia and hyperglycemia, and when using insulin might be appropriate.\u003C\u002Fp>",{"type":230,"data":235},{"readDurationInSeconds":236,"title":237,"text":238},11.200000000000001,"Join our Diabetes Mellitus Masterclass course today!","\u003Cp>Learn how to manage diabetes with confidence! In our \u003Cstrong>\u003Ca href=\"https:\u002F\u002Fwww.medmastery.com\u002Fcourse\u002Fdiabetes-mellitus-masterclass\">Diabetes Mellitus Masterclass\u003C\u002Fa> \u003C\u002Fstrong>course, you'll learn how to fine-tune your patient's treatment plans, confidently initiate, adjust, and manage insulin regimes, and screen for diabetic complications with total ease.\u003C\u002Fp>",{"type":240,"data":241},"cta",{"readDurationInSeconds":242,"text":243,"buttonText":244,"buttonUrl":245},3.466666666666667,"Become a great clinician with our video courses and workshops","Start learning for free","https:\u002F\u002Fwww.medmastery.com\u002Fuser\u002Fregister",{"type":230,"data":247},{"readDurationInSeconds":248,"text":249},0,"\u003Cp>\u003Cmeta charset=\"utf-8\">\u003C\u002Fp>",{"type":230,"data":251},{"readDurationInSeconds":252,"title":253,"text":254},121.33333333333333,"Video Transcript","\u003Cp dir=\"ltr\">\u003Cb id=\"docs-internal-guid-1ed587cc-7fff-c86f-526b-f53c998fd3a6\">[00:00:00] \u003C\u002Fb>As we discussed earlier in the course, it's important to individualize the glycemic targets for our patients. One group in which we particularly need to consider our goals is with elderly patients. There are a number of factors to keep in mind with older patients. First, is the intensity of treatment. While the guidelines recommend A1c target between 6.5% and 7% for most patients with diabetes, a more appropriate goal for older patients may be 7% to 8%. This minimizes \u003C\u002Fp>\u003Cp dir=\"ltr\">\u003Cb id=\"docs-internal-guid-1ed587cc-7fff-c86f-526b-f53c998fd3a6\">[00:00:30] \u003C\u002Fb>the risks of hypoglycemia while preventing symptoms of hyperglycemia. Elderly patients are at higher risk of hypoglycemia for several reasons. Often, elderly patients are on medications such as beta-blockers, which can mask the symptoms of hypoglycemia. They may not notice the typical adrenergic symptoms such as sweating or tremor. Neuroglycopenic symptoms instead such as dizziness, weakness or delirium may predominate a hypoglycemic episode, thus, these episodes can be missed or misinterpreted in elderly patients. \u003C\u002Fp>\u003Cp dir=\"ltr\">\u003Cb id=\"docs-internal-guid-1ed587cc-7fff-c86f-526b-f53c998fd3a6\">[00:01:00] \u003C\u002Fb>the glomerular filtration rate tends to decrease with age, leading to reduced renal clearance, which can potentiate the effect of renally-cleared diabetes medications and increase the risk of hypoglycemia. Elderly patients are also at increased risk for morbidity due to hypoglycemia, which can cause falls leading to fractures and can even cause cardiac arrhythmias. However, it's important to avoid hyperglycemia as this can negatively impact a patient's quality of life with urinary incontinence, dehydration \u003C\u002Fp>\u003Cp dir=\"ltr\">\u003Cb id=\"docs-internal-guid-1ed587cc-7fff-c86f-526b-f53c998fd3a6\">[00:01:30] \u003C\u002Fb>as well as visual impairment. Older patients are also at higher risk of side effects from their medications. Metformin is a good option for most as it has minimal side effects. Sulfonylureas may also be a good option as they too have minimal side effects, but you do need to be cautious of the increased risk of hypoglycemia with the sulfonylureas. DPP-4 inhibitors are one of the best options for oral medications in elderly patients. They have very low rates of side effects, are generally well-tolerated, and have a low risk \u003C\u002Fp>\u003Cp dir=\"ltr\">\u003Cb id=\"docs-internal-guid-1ed587cc-7fff-c86f-526b-f53c998fd3a6\">[00:02:00] \u003C\u002Fb>of hypoglycemia. They're not as effective as some of our other diabetes medications but as you adjust your A1c target for your older patients, they may be adequate. Certain medications should be avoided in elderly patients. While the TZDs are less likely to cause hypoglycemia than other diabetes medications, they do increase the risk of fractures, which can be quite serious in the elderly population, particularly those with underlying osteoporosis or who are at high fall risk. While the GLP-1 receptor agonists may be well tolerated \u003C\u002Fp>\u003Cp dir=\"ltr\">\u003Cb id=\"docs-internal-guid-1ed587cc-7fff-c86f-526b-f53c998fd3a6\">[00:02:30]\u003C\u002Fb> by some, you should use caution regarding the risk of nausea and weight loss with frail elderly patients. Finally, the SGLT-2 inhibitors may increase urinary frequency and genital yeast infections, which can be problematic for older patients, particularly those with mobility issues who may have trouble getting to the bathroom frequently. They may also lower blood pressure to the point that patients suffer orthostasis increasing their fall risk. If blood glucose control with metformin, DPP-4 inhibitors, and other \u003C\u002Fp>\u003Cp dir=\"ltr\">\u003Cb id=\"docs-internal-guid-1ed587cc-7fff-c86f-526b-f53c998fd3a6\">[00:03:00] \u003C\u002Fb>low-risk medications isn't adequate, you can consider low-dose insulin. In elderly patients, I typically start with basal insulin only, particularly if their food intake is unpredictable. If patients have significant insulin resistance, you can safely add mealtime insulin although you should be conservative with your dosing. In general, the goal with elderly patients is to avoid symptoms of hypoglycemia and hyperglycemia, not achieve tight glucose control.\u003C\u002Fp>",{"courses":256,"showAwardsBelow":48},[],{"id":258,"name":259,"image":260,"profession":261,"relativeUrl":264,"specializations":265},3748,"Tracy Tylee, MD","https:\u002F\u002Fmedmastery-backend-prod-kjbeds.s3.eu-west-1.amazonaws.com\u002Fmedia\u002Fimages\u002F9c43cefc-88e6-4632-a711-cf90c6d98c24",{"name":262,"description":263},"Endocrinologist","Tracy is an Associate Professor of Endocrinology at the University of Washington, and Program Director for the Endocrinology Fellowship Program.","\u002Fteachers\u002Ftracy-tylee-md",[266],"Endocrinology",154,"3m",[270,297,316],{"id":271,"title":272,"text":273,"image":274,"author":282,"path":291,"readDuration":292,"readDurationFormatted":268,"internal":293},1350,"How to Recognize INOCA (ANOCA) on an Exercise Stress Test ","Angina, abnormal stress test, clean coronaries—that's INOCA (or ANOCA), and it carries real risk. Learn to recognize and report it with exercise stress ECG.",{"alt":275,"title":276,"size":277,"location":279},"Illustration of the heart's coronary vasculature showing large coronary arteries and the extensive network of smaller vessels affected in INOCA (ischemia with nonobstructive coronary arteries).","",{"width":278,"height":278},1200,{"bucket":280,"key":281},"public-drupal-medmastery-assets-production","\u002F2026-05\u002FC17(1)_magazine image_0.png",{"id":283,"title":284,"relativeURL":285,"image":286,"professionLong":287,"profession":288,"weight":290},1563,"Franz Wiesbauer, MD MPH","\u002Fteachers\u002Ffranz-wiesbauer-md-mph","https:\u002F\u002Fmedmastery-backend-prod-kjbeds.s3.eu-west-1.amazonaws.com\u002Fmedia\u002Fimages\u002F9c43cef0-41ee-4005-9e4a-d8711c816401","Franz is the founder and CEO of Medmastery. He is an internist with a specialization in cardiology and a master’s in public health from Johns Hopkins University.",{"name":289},"Internist",4,"\u002Fmagazine\u002Fexercise-stress-ecg-inoca",141,{"created":294,"updated":295,"published":296},1778115738,1778118425,1778118255,{"id":298,"title":299,"text":300,"image":301,"author":307,"path":309,"readDuration":310,"readDurationFormatted":311,"internal":312},1348,"Hyperlipidemia screening: who, when, & what to measure","Testing for hyperlipidemia can help you mitigate your patients' cardiovascular risk. Learn who to screen and when, which measures to request, and how to stratify risk.",{"alt":302,"title":276,"size":303,"location":305},"Lipid panel blood sample tubes used to test for hyperlipidemia in a laboratory setting",{"width":304,"height":304},600,{"bucket":280,"key":306},"\u002F2026-04\u002FC121_magazine image.png",{"id":283,"title":284,"relativeURL":285,"image":286,"professionLong":287,"profession":308,"weight":290},{"name":289},"\u002Fmagazine\u002Ftest-for-hyperlipidemia",246,"5m",{"created":313,"updated":314,"published":315},1777403036,1777572381,1777412421,{"id":317,"title":318,"text":319,"image":320,"author":325,"path":334,"readDuration":335,"readDurationFormatted":336,"internal":337},1347,"Outpatient care for COPD exacerbations","Most acute COPD exacerbations can be managed with outpatient treatment. Learn how to treat mild and moderate COPD exacerbations—and when to escalate care.",{"alt":321,"title":276,"size":322,"location":323},"Older patient using a handheld nebulizer to inhale bronchodilator medication during an acute COPD exacerbation",{"width":304,"height":304},{"bucket":280,"key":324},"\u002F2026-04\u002FC133(4)_ exacerbations_magazine image.png",{"id":326,"title":327,"relativeURL":328,"image":329,"professionLong":330,"profession":331,"weight":333},5365,"Siamak Moayedi, MD","\u002Fteachers\u002Fsiamak-moayedi-md","https:\u002F\u002Fmedmastery-backend-prod-kjbeds.s3.eu-west-1.amazonaws.com\u002Fmedia\u002Fimages\u002F9c43cf02-1064-4074-817b-0eb5de6ded74","Professor and Director of Medical Student Education, University of Maryland and Course Director, Essential and Critical Procedures, Emergency Medicine.",{"name":332},"Emergency medicine physician",1533,"\u002Fmagazine\u002Facute-copd-exacerbation-treatment",191,"4m",{"created":338,"updated":339,"published":340},1776705362,1776710540,1776710541,{"seo":342,"og":344},{"title":343,"description":213},"Adjusting diabetes management for older patients | Medmastery",{"title":343,"description":213,"image":345},{"alt":276,"title":276,"size":346,"location":349},{"width":347,"height":348},684,397,{"bucket":280,"key":350},"\u002Fmigrated-images\u002FScreen Shot 2018-11-15 at 11.00.35 am.png",{"id":352,"created":353,"updated":354,"published":353},278,1545314783,1655189586]